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Presented by Ralph Hruban, M.D. and prepared by Danielle Wehle, M.D.
Case 3: This middle-aged woman with abdominal pain was found to have a large pancreatic mass.
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1. Question
Week 280: Case 3
This middle-aged woman with abdominal pain was found to have a large pancreatic mass./images/rhh8213a.jpg
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Answer: Well-differentiated pancreatic endocrine neoplasm
Histology: This cellular neoplasm is composed of large cells with abundant pink cytoplasm and uniform nuclei. Extensive local invasion is noted.
Discussion: The differential diagnosis for cellular pancreatic neoplasm should include Acinar Cell Carcinoma, Well-Differentiated Pancreatic Endocrine Neoplasm, Solid-pseudopapillary Neoplasm, and Pancreatoblastoma. Acinar cell carcinomas typically have single prominent nucleoli and will express exocrine enzymes (trypsin, chymotrypsin, lipase), well-differentiated pancreatic endocrine neoplasms have uniform nuclei with “salt and pepper” chromatin and they express markers of endocrine differentiation (chromogranin and synaptophysin). Solid-pseudopapillary neoplasms occur predominantly in young women and are composed of poorly cohesive cells surrounding delicate fibrovascular papillae. They label with antibodies to CD10 and beta-catenin. Pancreatoblastomas have acinar differentiation and contain squamoid nests.
Incorrect
Answer: Well-differentiated pancreatic endocrine neoplasm
Histology: This cellular neoplasm is composed of large cells with abundant pink cytoplasm and uniform nuclei. Extensive local invasion is noted.
Discussion: The differential diagnosis for cellular pancreatic neoplasm should include Acinar Cell Carcinoma, Well-Differentiated Pancreatic Endocrine Neoplasm, Solid-pseudopapillary Neoplasm, and Pancreatoblastoma. Acinar cell carcinomas typically have single prominent nucleoli and will express exocrine enzymes (trypsin, chymotrypsin, lipase), well-differentiated pancreatic endocrine neoplasms have uniform nuclei with “salt and pepper” chromatin and they express markers of endocrine differentiation (chromogranin and synaptophysin). Solid-pseudopapillary neoplasms occur predominantly in young women and are composed of poorly cohesive cells surrounding delicate fibrovascular papillae. They label with antibodies to CD10 and beta-catenin. Pancreatoblastomas have acinar differentiation and contain squamoid nests.
